Raynaud Disease

Raynaud disease is the tendency of cold temperatures and anxiety to trigger spasms in the arteries of the arms and legs, which causes skin discoloration and discomfort. Children who have this condition may have no other health problems, or they may have an underlying immune disease, such as lupus. When Raynaud disease occurs with no underlying disease, it is called Raynaud's phenomenon.

A three-phase color change is indicative of Raynaud’s disease:

The skin first turns a bluish color, accompanied by an ache.

Next, the child notices a sharper pain and white discoloration of the affected area.

After an hour or more, the spasm is released; a prickly feeling and a reddish purple color flushes the affected skin.

The symptoms of Raynaud disease are usually brought on by exposure to cold air temperature or by touching something icy. Reaction to emotional stress can also trigger the condition. In its severest form, if left untreated, the condition can rarely lead to a shutdown of blood vessels and breakdown of tissue in the affected areas.

If you believe your child may have Raynaud disease, you should seek the evaluation of a pediatric rheumatologist who can make a correct diagnosis: Many teens have hyper-reactivity of their blood vessels that is less severe and does not lead to tissue injury. This is called acrocyanosis, and it is not harmful.

Diagnosis of Raynaud Disease

In diagnosing Raynaud disease, your child’s doctor will determine if there is an underlying immune disease causing the condition, which is known as secondary Raynaud phenomenon. If your child has no underlying medical condition causing this condition, then he or she is said to have primary Raynaud disease. Because there is no single blood test that can help your child’s doctor pinpoint Raynaud specifically, one or more of the following tests may be performed to determine if your child has a related or underlying condition:

Capillaroscopy. During this test, your child’s doctor examines the nail fold (the skin at the base of the fingernail) under a microscope. If the tiny blood vessels (capillaries) near the nail fold are enlarged or deformed, your child may have an underlying disease that is causing Raynaud.

Antinuclear antibodies test. Your child’s doctor may use this blood test to check for the presence of certain antibodies, which can indicate a stimulated immune system that is common in people with Raynaud and other underlying conditions, such as autoimmune diseases.

Erythrocyte sedimentation rate. Your child’s doctor may use this blood test to determine the rate at which the blood cells settle at the bottom of a test tube. A fast rate can indicate an underlying inflammatory or autoimmune disorder.

The above tests can help indicate if Raynaud disease is likely to need treatment and determine whether another condition is likely to be present.

Treatments

Treatments

Your child’s doctor will prescribe the course of treatment best suited to his or her specific case of Raynaud. Treatment may include one or more of the following:

Anti-inflammatory medicines. Anti-inflammatory medicines may be used to reduce inflammation associated with the condition.

Vasodilators. Vasodilators relax the blood vessels, helping to reduce the spasms of the blood vessels that occur with Raynaud's.

Nitroglycerin paste. Your child’s rheumatologist may suggest applying nitroglycerin paste to the affected areas to open up the blood vessels, which stimulates flushing and warmth and better blood flow to the skin.

Calcium channel blockers. Calcium channel blockers relax and open the small blood vessels in your child’s hands and feet, which decreases the frequency and severity of Raynaud attacks.

Your child’s doctor may recommend avoiding over-the-counter cold and sinus medications that contain pseudoephedrine and beta blockers. These medicines can aggravate the symptoms of Raynaud disease.

It is important to note that the primary symptom of another condition called acrocyanosis can mimic the first phase of Raynaud disease. Acrocyanosis causes a persistent, dusky blue and cold feeling in the feet and hands. The condition is frequently seen in adolescents who are experiencing normal hormone changes during puberty or are on medicines for attention-deficit/hyperactivity disorder (ADHD). Those who have blue discoloration of the skin but never exhibit the other color changes associated with Raynaud do not have Raynaud disease and have low risk of tissue injury.

Key Points to Remember

Key Points to Remember

Raynaud disease—and related Raynaud's phenomenon—is the tendency of cold temperatures to trigger spasms in the arteries of the arms and legs, which causes skin discoloration and discomfort, usually in the hands and feet.

The symptoms of Raynaud disease are usually brought on by exposure to cold air temperature or by touching something icy. They may also be triggered by anxiety.